| NPI | 1104416247 |
|---|---|
| Doing Business As | PROVIDENTIAL HOME CARE |
| Entity Type | Organization |
| Authorized Contact | MARK KERSEY Owner 479-668-4338 |
| Organization Subpart ? | No |
| Primary Taxonomy | 253Z00000X In Home Supportive Care |
| Enumeration Date | 2021-01-22 |
| Last Update Date | 2021-01-22 |